Contraception and Family Planning Practice Questions

Q: Oral contraceptives increase the risk of all the following conditions except?

Ovarian cancer. **Explanation:** The correct answer is **Ovarian cancer** because Combined Oral Contraceptive Pills (COCPs) are actually **protective** against it. **1. Why Ovarian Cancer is the Correct Answer:** COCPs suppress ovulation by inhibiting the release of FSH and LH. According to the "Incessant Ovulation Theory," reducing the number of ovulatory cycles decreases repetitive trauma to the ovarian epithelium. This leads to a significant reduction (approx. 50%) in the risk of epithelial ovarian cancer. This protective effect begins after 3–6 months of use and persists for up to 15–20 years after discontinuation. **2. Analysis of Incorrect Options:** * **Breast Cancer:** Most studies indicate a slight, transient increase in the relative risk of breast cancer among current and recent users. The risk typically returns to baseline 10 years after stopping. * **Cervical Cancer:** Long-term use of COCPs (over 5 years) is associated with an increased risk of cervical cancer, likely due to hormonal influences on the transformation zone and a possible association with increased exposure to HPV. * **Liver Cancer:** COCPs are linked to an increased risk of benign liver tumors (Hepatic Adenoma) and, in rare cases, have been associated with an increased risk of Hepatocellular Carcinoma (HCC). **High-Yield Clinical Pearls for NEET-PG:** * **Protective Effects:** COCPs reduce the risk of **Ovarian, Endometrial, and Colorectal cancers.** * **Increased Risk:** COCPs increase the risk of **Breast, Cervical, and Liver cancers.** * **Non-Contraceptive Benefits:** They are used to manage dysmenorrhea, menorrhagia, and PCOS, and they decrease the incidence of Benign Breast Disease (BBD) and Pelvic Inflammatory Disease (PID).

Q: Which one of the following is the most suitable situation for prescribing the progestin-only pill for the purpose of contraception?

Lactational mother. **Explanation:** The **Progestin-Only Pill (POP)**, also known as the "mini-pill," is the contraceptive of choice for **lactating mothers** (Option C). Unlike Combined Oral Contraceptives (COCs), POPs do not contain estrogen. Estrogen is known to suppress prolactin, thereby decreasing the quantity and quality of breast milk. Progestins, however, have no adverse effect on lactation and are safe for the infant, making them ideal for use starting 6 weeks postpartum. **Analysis of Incorrect Options:** * **Active Liver Disease (Option B):** This is a **strict contraindication** for almost all hormonal contraceptives, including POPs. Steroid hormones are metabolized in the liver; impaired hepatic function can lead to hormone accumulation and further liver stress. * **Perimenopausal Patients (Option A):** While POPs can be used, they are often not the "most suitable" due to the high incidence of irregular spotting and breakthrough bleeding—side effects that can mask endometrial pathology (like hyperplasia or malignancy) common in this age group. * **Diabetes (Option D):** While POPs are generally safe in diabetics without vascular complications, they are not specifically "indicated" for them over other methods. In fact, certain progestins can slightly affect carbohydrate metabolism. **High-Yield NEET-PG Pearls:** * **Mechanism of Action:** POPs primarily work by thickening cervical mucus (preventing sperm penetration) and making the endometrium atrophic. They do not consistently inhibit ovulation (unlike COCs). * **The "3-Hour Rule":** POPs must be taken at the same time every day. A delay of more than 3 hours is considered a "missed pill." * **Ideal Candidate:** Women with contraindications to estrogen (e.g., breastfeeding, smokers >35 years, history of DVT, or migraine with aura).

Q: What is the dose of ulipristal acetate when used for emergency contraception?

30 mg. **Explanation:** Ulipristal acetate (UPA) is a selective progesterone receptor modulator (SPRM) and is currently considered the most effective oral emergency contraceptive (EC). **1. Why 30 mg is correct:** The standard dose for emergency contraception is a **single 30 mg tablet** taken orally. Its primary mechanism of action is the inhibition or delay of ovulation. Unlike Levonorgestrel (LNG), which is only effective before the LH surge begins, Ulipristal can delay ovulation even after the LH surge has started (but before it peaks), making it effective for up to **120 hours (5 days)** after unprotected intercourse. **2. Why other options are incorrect:** * **300 mg (Option A):** This is a massive overdose for EC. Higher doses of UPA (e.g., 5-10 mg daily) are used for the medical management of uterine fibroids, but 300 mg is not a standard clinical dose. * **300 µg and 30 µg (Options C & D):** These doses are far too low to inhibit ovulation. For comparison, the "Minipill" (Progestogen-only pill) typically contains doses in the microgram range (e.g., Levonorgestrel 30 µg), but emergency contraception requires a much higher "stat" dose to be effective. **High-Yield Clinical Pearls for NEET-PG:** * **Window of Efficacy:** Ulipristal is effective up to 120 hours (5 days), whereas LNG is ideally taken within 72 hours. * **Efficacy in Obesity:** Ulipristal is more effective than LNG in women with a BMI >30 kg/m². * **Breastfeeding Caution:** Women should avoid breastfeeding for **one week** after taking Ulipristal (express and discard milk), unlike LNG which is safe during lactation. * **Drug Interaction:** Do not start hormonal contraception (like OCPs) for at least 5 days after taking UPA, as they may interfere with each other's efficacy.

Q: All the following are contraindications for copper-containing IUCDs except?

Ischemic heart disease. **Explanation:** The correct answer is **Ischemic Heart Disease (IHD)**. According to the WHO Medical Eligibility Criteria (MEC), IHD is classified as **Category 1** for Copper IUCDs (Cu-IUD), meaning there is no restriction for its use. Unlike hormonal contraceptives (like OCPs), Cu-IUDs do not contain estrogen or progestogens, which are associated with thromboembolic risks and adverse lipid profiles. Therefore, they are safe for women with cardiovascular conditions. **Analysis of Contraindications:** * **Wilson’s Disease (Option A):** This is a specific contraindication for **Copper-containing** IUCDs because the device can potentially interfere with copper metabolism or exacerbate the systemic copper burden in these patients. (Note: LNG-IUS is an alternative here). * **Pregnancy (Option B):** This is an absolute contraindication (MEC Category 4). Insertion during pregnancy can lead to septic abortion, pelvic infection, or preterm labor. * **Undiagnosed Genital Bleeding (Option C):** This is a Category 4 contraindication. Insertion must be delayed until a serious underlying pathology (like endometrial or cervical malignancy) is ruled out, as the IUCD may worsen bleeding or complicate the diagnosis. **High-Yield Clinical Pearls for NEET-PG:** * **MEC Category 4 (Absolute Contraindications):** Current PID, unexplained vaginal bleeding, copper allergy (for Cu-IUD), and gestational trophoblastic disease with high hCG levels. * **Ideal Candidate:** A parous woman in a stable monogamous relationship with no history of PID. * **Most Common Side Effect:** Increased menstrual blood loss (menorrhagia) and dysmenorrhea. * **Most Common Reason for Removal:** Excessive menstrual bleeding. * **Post-exposure Prophylaxis:** Cu-IUD is the most effective emergency contraceptive if inserted within 5 days of unprotected intercourse.

Q: A 28-year-old female presents with irregular slight bleeding after taking combined oral contraceptive pills for three months to manage heavy menstrual bleeding. What is your advice?

Reassure the patient as this is breakthrough bleeding.. **Explanation:** **1. Why Option C is Correct:** The patient is experiencing **breakthrough bleeding (BTB)**, which is the most common side effect of Combined Oral Contraceptive Pills (COCPs), especially during the first **3–6 months** of use. This occurs because the exogenous hormones cause the endometrium to become thin and fragile, leading to asynchronous breakdown and spotting. Since the patient has only been on the pills for three months, the initial management is **reassurance and observation**, as this side effect usually resolves spontaneously once the endometrium stabilizes. **2. Why Other Options are Incorrect:** * **Option A:** Endometrial sampling is generally reserved for women >35 years or those with persistent abnormal uterine bleeding (AUB) despite medical therapy. In a 28-year-old with a clear pharmacological cause (COCP initiation), neoplasia is highly unlikely. * **Option B:** Progestin-only preparations (POPs) are actually *more* likely to cause irregular spotting and breakthrough bleeding compared to COCPs due to the lack of estrogen-induced endometrial stabilization. * **Option D:** Discontinuing the pills is unnecessary and would lead to the return of her original complaint (heavy menstrual bleeding) and loss of contraceptive protection. **Clinical Pearls for NEET-PG:** * **Breakthrough Bleeding (BTB):** Most common in the first 3 cycles. * **Management of persistent BTB:** If bleeding persists beyond 3 months, the dose of estrogen can be increased or the type of progestin changed. * **Early vs. Late Cycle Bleeding:** * Bleeding in the **early/follicular phase** suggests estrogen deficiency (increase estrogen). * Bleeding in the **late/luteal phase** suggests progestin deficiency (increase progestin). * **Most common cause of BTB:** Missing a pill (non-compliance). Always rule this out first in clinical practice.

Q: Which of the following is NOT used as emergency contraception?

Saheli. **Explanation:** The correct answer is **Saheli (Centchroman)**. **1. Why Saheli is the correct answer:** Saheli is a **Selective Estrogen Receptor Modulator (SERM)**. It is used as a **non-steroidal, weekly oral contraceptive pill** for routine birth control, not for emergency use. Its mechanism involves altering the uterine endometrium to prevent implantation and speeding up ovum transport. Because it requires a steady-state buildup (taken twice weekly for the first 3 months, then once weekly), it is ineffective as a post-coital emergency measure. **2. Why the other options are incorrect (Emergency Contraceptive Methods):** * **Combined Oral Contraceptive Pills (COCs):** Used in the **Yuzpe Regimen**. It involves taking two doses (each containing 100 mcg Ethinyl Estradiol + 0.5 mg Levonorgestrel) 12 hours apart within 72 hours of intercourse. * **Intrauterine Device (IUD):** The **Copper T-380A** is the **most effective** emergency contraceptive. It can be inserted up to 5 days (120 hours) after unprotected intercourse and prevents pregnancy by interfering with fertilization and implantation. * **High-dose Estrogen:** Historically used (e.g., Ethinyl Estradiol 5mg daily for 5 days), this method is now largely obsolete due to severe side effects like nausea and vomiting, but it remains a recognized pharmacological method for emergency contraception. **High-Yield Clinical Pearls for NEET-PG:** * **Drug of Choice (DOC):** Levonorgestrel (LNG) 1.5 mg single dose (within 72 hours) is the current standard. * **Most Effective Method:** Copper IUD (failure rate <0.1%). * **Ulipristal Acetate:** A Selective Progesterone Receptor Modulator (SPRM) effective up to 120 hours (5 days); it is more effective than LNG in obese women. * **Mifepristone:** Can be used as an emergency contraceptive in low doses (10–25 mg).

Q: What is true about Mirena?

A progestogen-containing intrauterine device. **Mirena** is a Levonorgestrel-releasing Intrauterine System (LNG-IUS). It is a T-shaped plastic device that serves as a highly effective, long-acting reversible contraceptive (LARC). ### **Explanation of Options:** * **A is Correct:** Mirena contains **Levonorgestrel (LNG)**, which is a second-generation synthetic **progestogen**. It releases approximately 20 µg of LNG directly into the uterine cavity every 24 hours. * **B is Incorrect:** It contains **Levonorgestrel**, not desogestrel. Desogestrel is commonly found in third-generation combined oral contraceptive pills (COCPs) or progestogen-only pills (Cerazette). * **C is Incorrect:** Progestogens cause **endometrial atrophy**, not hyperplasia. By suppressing the proliferative effect of estrogen, Mirena thins the endometrial lining, which is why it is used as a first-line treatment for Heavy Menstrual Bleeding (HMB). * **D is Incorrect:** Mirena significantly affects menses. Initially, it may cause irregular spotting, but it eventually leads to **amenorrhea** in approximately 20-40% of users after one year due to profound endometrial suppression. ### **High-Yield Clinical Pearls for NEET-PG:** * **Mechanism of Action:** Primarily works by thickening cervical mucus (preventing sperm penetration) and causing endometrial atrophy (preventing implantation). It does not consistently inhibit ovulation. * **Duration:** Approved for use for up to **8 years** (recently updated from 5 years). * **Non-Contraceptive Uses:** First-line management for **Idiopathic Menorrhagia**, management of endometriosis, and as the progestogen component of Hormone Replacement Therapy (HRT) to protect the endometrium. * **Pearl:** Unlike Copper-T, Mirena **decreases** the risk of Pelvic Inflammatory Disease (PID) by thickening the cervical mucus plug.

Question 1

Oral contraceptives increase the risk of all the following conditions except?

Accepted Answer

Ovarian cancer

Answer

Breast cancer

Answer

Cervical cancer

Answer

Liver cancer

Question 2

Which one of the following is the most suitable situation for prescribing the progestin-only pill for the purpose of contraception?

Accepted Answer

Lactational mother

Answer

Perimenopausal patients

Answer

Active liver disease

Answer

Diabetes

Question 3

Which is the ideal contraceptive for a couple who have infrequent coital frequency due to professional commitments?

Accepted Answer

Barrier method

Answer

Intrauterine contraceptive device (IUCD)

Answer

Oral contraceptive pill (OCP)

Answer

Depot medroxyprogesterone acetate (DMPA)

Question 4

What is the dose of ulipristal acetate when used for emergency contraception?

Accepted Answer

30 mg

Answer

300 mg

Answer

300 µg

Answer

30 µg

Question 5

All the following are contraindications for copper-containing IUCDs except?

Accepted Answer

Ischemic heart disease

Answer

Wilson's disease

Answer

Pregnancy

Answer

Undiagnosed genital bleeding

Question 6

With contraceptive failure, which method has a relatively increased risk of ectopic pregnancy?

Accepted Answer

Tubal sterilization

Answer

Condoms

Answer

Vasectomy

Answer

Vaginal ring

Question 7

A 28-year-old female presents with irregular slight bleeding after taking combined oral contraceptive pills for three months to manage heavy menstrual bleeding. What is your advice?

Accepted Answer

Reassure the patient as this is breakthrough bleeding.

Answer

Endometrial sampling to rule out neoplasia.

Answer

Change over to progestin-only preparations.

Answer

Discontinue oral contraceptive pills.

Question 8

Which of the following is NOT used as emergency contraception?

Accepted Answer

Saheli

Answer

Combined oral contraceptive pills

Answer

Intrauterine device (IUD)

Answer

High-dose estrogen for 5 days

Question 9

Depot medroxyprogesterone acetate is sparingly used as a contraceptive because it causes:

Accepted Answer

Irregular menstrual bleeding

Answer

Cardiovascular complications

Answer

Lactational failure

Answer

Breast cancer

Question 10

What is true about Mirena?

Accepted Answer

A progestogen-containing intrauterine device

Answer

Contains desogestrel

Answer

Causes endometrial hyperplasia

Answer

Has no effect on menses

Contraception and Family Planning — MCQs

Contraception and Family Planning — MCQs

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